Provider Demographics
NPI:1043459522
Name:MAZZARELLA, DONNA MARIA (RN)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIA
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 JUNEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2605
Mailing Address - Country:US
Mailing Address - Phone:440-871-1855
Mailing Address - Fax:
Practice Address - Street 1:526 JUNEWAY DR
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2605
Practice Address - Country:US
Practice Address - Phone:440-871-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN178983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse